Complaint Investigation Report

157208994-10-21-2021-24-AS-MHON-C8LMZL-20211109090320

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

This is an official report of an unannounced visit/investigation of a complaint received in our office on

05/18/2021 and conducted by Evaluator Malia Thao

COMPLAINT CONTROL NUMBER: 24-AS-20210518102759

On 10/21/21 at 10:45 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint investigation and deliver findings. LPA met with Licensee (LIC) Jason Johnson.

During the course of the investigation, LPA made observations, conducted interviews, and reviewed records. Based on observations, interviews, and record review, LPA found that staff are listed as scheduled at both facility and LIC's facility next door. LIC admits staff will go work at facility next door to help and is not barred from doing so when working alone. The above allegation is substantiated.

Deficiency is being cited based on LPA observations, interviews, and record review in accordance with the California Code of Regulations, Title 22, see LIC9099D.

Exit interview conducted. A copy of this report and appeal rights were discussed and emailed to facility's email address on record, with "Read receipt" to confirm receipt of this report.